This well-crafted, revised application proposes a partnership between Drs. Inciardi and Surratt from the University of Delaware and Dr. Pechansky from the Federal University of Rio Grande do Sul. Together, they would explore the emerging club drug epidemic in the Southern part of Brazil. The topic is interesting and the data will be useful to understand the emerging problem of club drugs and raves in Brazil. The research team is strong, the methodology is sound and they have responded adequately to all of the concerns expressed in the previous review. The panel thought that the project would benefit from some baseline questions about tobacco use in the standard interview and they were concerned by the lack of attention to HIV/AIDS transmission risks connected with the club drug scene. The proposal states that they will distribute "harm reduction" literature at club events and that is positive. However, plans are not fully laid out for developing an intervention that is culturally appropriate and effective for this population. Nevertheless, these were not major weaknesses and the review committee thought that the proposal was outstanding. DESCRIPTION (provided by applicant): Since the 1970s there has been the emergence and expansion of the so-called "club drugs" and "club culture." Club drugs (alternatively called "rave drugs," "dance drugs" and "party drugs") is a vague term that refers to a wide variety of substances, yet in the U.S. the most popular of the club drugs have been MDMA (ecstasy), GHB, ketamine, LSD, methamphetamine, and a few prescription drugs, such as dextroamphetamine and methylphenidate. Recently, reports in both popular and scientific media have begun to indicate that ecstasy use is increasing markedly in many parts of Brazil. Although ecstasy was first introduced in Brazil as early as 1994, by most accounts its use remained localized and sporadic until 2000-2001. Currently, ecstasy use has spread to most major cities in Brazil, and occurs primarily in rave and night-club settings. The handful of published studies on this topic in Brazil suggests that ecstasy users are often polydrug abusers, and have significantly higher rates of illicit and prescription drug abuse than do non-ecstasy users. Because of the young age of the vast majority of club drug users and their tendency to mix numerous drugs during their typical drug binges, club drug users tend to be a highly vulnerable population. However, there are few published scientific studies of the health and social consequences of club drug use in general, and none that have been conducted in Brazil. Within this context, the overall goal of the proposed study is to develop the capacity of local investigators to address this emerging health problem through a collaborative research process. The specific aims of the proposed study are to: 1) Recruit a sample of 200 out-of-treatment club drug users ages 18-39 in Porto Alegre, Brazil, and at baseline assess their life histories of alcohol and drug abuse onset and progression (changes in quantity, frequency, and types), and extent of current alcohol, club, prescription, and other drug use;2) at 6 and 12 months, assess changes in onset, progression, and extent of respondents'alcohol and club, prescription, and other drug use;3) at baseline, 6 months, and 12 months, investigate the impact of quantity, frequency, types and duration of drug abuse on the nature and extent of health and social consequences within this population, including: sexual risk-taking and coercion;drug interactions and overdose;chronic drug use;impairment of daily activities;physical problems;mental health problems;and legal problems;and 4) examine the impact of gender on onset, progression, and extent of drug use and the nature and extent of health and social consequences. Data analyses will use a variety of statistical techniques to describe the population, the epidemiology of club, prescription and other drug use, and the nature and prevalence of related health consequences. This research will be conducted in Porto Alegre, Brazil, at the Federal University of Rio Grande do Sul in collaboration with Dr. Flavio Pechansky, as an extension of NIH grant #R01DA019048 (Inciardi, PI). The proposed exploratory project represents a significant first step in the process of better understanding the emerging club drug epidemic in the South of Brazil. Preliminary studies in Miami suggest that club drug users are at high risk for both physical and mental health consequences requiring intervention, particularly those who also abuse prescription drugs, and it would appear that the abuse of prescription drugs is an emergent problem in Brazil as well. The proposed work will begin to identify the nature and extent of the consequences of club and prescription drug abuse in the Brazilian context - information from which appropriate interventions, health services, and prevention policies can ultimately be developed. As a first step, the data collected will be used to generate Portuguese language training materials that will be made available to local treatment providers and health practitioners.